Researchers Explain Their County-Level Estimates of Texas ACA Insurance Coverage & Medicaid Expansion

Anne Dunkelberg

Last Friday was a circus for Medicaid and health care watchers.  Just down the hall, as the hearing we blogged about earlier this week went into its third hour of Medicaid Expansion discussion, 80-something Capitol folk tore themselves away from the hearing to attend our research briefing, sponsored by Methodist Healthcare Ministries, exploring similar ground.  Our speakers laid out two recent academic models of the impact of insurance coverage gains under the ACA in each Texas by county.

The first report was developed in 2012 by Dr. Steve Murdock and Dr. Michael Cline of the Hobby Center for the Study of Texas at Rice University.  Dr. Cline described how they built the model before the Supreme Court decision that made the Medicaid expansion for near-and-below poverty adults optional for states—and left that group without an affordable coverage option under the ACA in states that do not expand Medicaid.  

Dr Murdock noted that their coverage estimates are higher than those of LBB, and indicated with a smile he believes his team’s model is better.  The researchers showed how their model of US citizen adults below 138 percent FPL and children to 200 percent FPL in Texas is very close in size to the HHSC’s estimates of adults potentially covered and the  higher “welcome” enrollment by already-eligible children.  A key finding was that the Medicaid-income level enrollment is projected to make up about 49% of the overall reduction in Texas uninsured.  CPPP presented a few quick slides updating the status of Medicaid expansion in Texas and across the states.

The Hobby center model has been used for several other studies of the ACA’s impact in Texas.  CPPP published county-level fact sheets detailing how many county residents gain insurance with and without the Medicaid expansion, paired with estimates of the new federal Medicaid dollars spent by county through 2017, based on Texas HHSC’s data.  Billy Hamilton Associates published an important report on the potential savings and benefits for state and county governments using the Hobby Center model, also commissioned by MHM along with Texas Impact.

And, Dr Leighton Ku from the School of Public Health and Health Services at the George Washington University used the model to look at access to primary care in Texas and how increased insured rates—with and without Medicaid expansion—will affect the access issues.

He explained that Texas’ statewide primary care capacity today is well below the national average, but the average hides much deeper access problems in pockets across the state.  Noting that higher insured rates will not change Texas’ health needs but will increase demand, he said that the ACA coverage increases (from both private and public insurance) will create short term demand pressures.

But in the longer term, he said, insurance expansion could help build primary care capacity.  Texas’ low primary care capacity is partly due to our high uninsured rate, because not enough paying patients can make it hard for physicians to make a living, particularly in rural areas.  In addition, he said, Medicaid expansion and private insurance coverage would fuel major employment growth in health care.

The briefing closed with invited comments from the Texas Hospital Association, Texas Academy of Family Physicians, and Texas Association of Community Health Centers.  All speakers applauded new hard-negotiated progress toward a broader scope of practice by Advance Practice Nurses and Physician Assistants in Texas.  The need for more public investment to keep Texas medical students practicing here in Texas, and for health care systems to evolve to support professionals who expect time for child-rearing and family life was discussed.  Finally, each commenter agreed that Texas’ ability to grow the primary care workforce will be much stronger with the additional $6 billion per year in net federal Medicaid payments for health care from 2014-2017 that HHSC projects will be spent if we move ahead with a Medicaid expansion.

Videotapes of the researcher’s remarks will be posted at Methodist Healthcare Ministries’ web page soon!

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